1. Field of the Invention
The present invention is broadly concerned with a system and method for conditional diagnosis, assessment and symptom tracking of patients having behavioral health and/or physical disorders. More particularly, it is concerned with a system and method for providing a health care practitioner with diagnostic criteria and assessment techniques for a particular disorder, recording a treatment plan, and tracking patient symptoms and responses to the treatment plan in order to assess, optimize and document symptom improvement under the treatment plan, as well as providing the patient and clinician with an education and interaction tool for facilitating communication between patient and practitioner regarding the nature of the disorder and purpose and progress of the treatment.
2. Description of the Related Art
Health care practitioners or clinicians voluntarily document observation and treatment of their patients so that they can monitor their treatment plans and make appropriate revisions to optimize patient symptom improvement. Such documentation is also required so that the quality of their care can be monitored by federal and state agencies, such as Medicare and Medicaid, and various private accreditation agencies, such as the Joint Committee on the Accreditation of Health Care Organizations. Clinicians also need to maintain adequate documentation in order to respond to requests from third party insurers for substantiation of patient claims for reimbursement.
Health care practitioners are trained to identify the symptoms of a patient, make a diagnosis of a disorder or disease, assess the severity of the disorder, develop a plan for treatment of the patient and track the progress of the treatment plan. To assist them in documenting these steps, clinicians generally dictate their notes of each patient visit. The notes are subsequently transcribed and maintained in a confidential record, or so-called “chart”. While the primary purpose of the chart is to assist the clinician with diagnosis and assessment of the patient's progress under the treatment plan, it also serves an important documentation function. Although the patient generally does not have access to the chart, information may be culled from it and provided to third parties such as insurance companies and various regulatory and accreditation agencies. Each of such third parties has its own documentary requirements, and any failure of the clinician to fully meet such requirements may result in negative consequences for both the clinician and the patient. For example, third party payors such as insurance companies frequently deny claims for reimbursement based on inadequate documentation of symptoms to support the diagnosis or progress under the treatment plan. And reimbursement may be denied for treatment which is expensive or long term in cases where progress cannot be demonstrated by familiar, objective methods, such as by laboratory testing.
In addition, such chart-type documentation methods produce a series of “snap shot” records of the patient's symptoms at each office visit. Over the course of treatment, the chart may become voluminous and time consuming for clinician review.
When a patient suffers from an injury or illness, a record of the patient's symptoms, diagnosis (whether the disorder exists), assessment (the severity of the condition once it is diagnosed) and the progress of the chosen treatment plan are relatively easy to document. However, when a patient suffers from physical symptoms having no observable underlying cause, or suffers from a disorder having behavioral or psychological symptoms, documentation of diagnosis, assessment and progress under the treatment plan can be substantially more difficult. Practitioners themselves may have difficulty tracking the effectiveness of treatment of such a patient.
In order to assist clinicians, various professional associations have developed criteria for use in establishing a diagnosis, conducting an assessment and evaluating the effectiveness of a treatment plan implemented by the practitioner. For example, the American Psychiatric association has developed the DSM-IV Diagnostic Criteria for Attention Deficit Hyperactivity Disorder (ADHD). A variety of diagnostic and assessment instruments have been implemented which employ such criteria.
Some instruments have been developed to assist in establishing a diagnosis, for example the Conners ADHD/DSM IV Scales. Some instruments, such as the Beck Depression Inventory, combine both diagnosis and assessment functions. Both of these types of instruments are generally in the form of questionnaires, which may be completed by a patient or by a health care practitioner during an interview with the patient. Such so-called self-reporting instruments include a set of predetermined questions which are answered by the patient. The responses may be forwarded to a testing center for visual or computerized scoring and the results returned to the patient's health care practitioner for interpretation. The responses may also be scored in the clinician's office. Alternatively, the health care practitioner may conduct a structured interview of the patient. As with self-reporting instruments, the patient's responses are scored and subsequently interpreted by the practitioner.
Once a conditional diagnosis and assessment have been made, the health care practitioner generally develops a treatment program consisting of prescribed medication and/or behavior management. Whether or not the diagnosis and assessment are conducted simultaneously and whether they are conducted by patient self-report or by structured interview, they provide a fixed record of the health status of the patient at the time the diagnosis and assessment are made. Some health care practitioners provide their patients with copies of the diagnosis and assessment scores. However, without clinical knowledge and experience, such scores generally provide a patient with little insight.
It is well known that the more targeted a treatment program is to a patient's own symptoms, the better the result. The effects of the treatment program on the patient's symptoms and development of any side-effects will determine whether the program requires modification. Thus, treatment is optimized by frequent periodic patient assessment during the course of the prescribed therapy. However, available assessment instruments provide one time, “snap shot” views, which are time consuming and require expensive subsequent scoring and analysis. Because they can only assess the patient's health status at the time of administration, they must be periodically readministered, scored and analyzed throughout the duration of the treatment program. Even then, the resulting multiplicity of scored assessment instruments in the patient's chart does not provide the clinician with a convenient, continuous summary of the patient's progress.
Some instruments, such as the Distressed Mood/Behavior Intervention Form have been developed for use as preprinted charts for institutionalized patients. These instruments are used by caregivers to document when a common behavioral symptom such as wandering occurs, the intervention, such as redirection, employed by the caregiver, and the initials of the caregiver observing the behavior. While such instruments provide a chart of patient behavior, they must be completed by the caregiver and do not include diagnostic and assessment criteria for any, particular illness, or permit tracking of the patient's progress in response to a treatment program.
The diagnostic and assessment criteria for some disorders, such as ADHD, are complex and the assessment depends heavily on the patient's recollection. Consequently, a health care practitioner may have difficulty obtaining a complete record of all reportable factors, including symptoms, settings and frequency at every office visit. The complexity of the disorder may also leave patients confused and with unanswered questions about their disorder and their impairment may prevent them from organizing their thoughts during the brief office visit. Patients may also need general advice regarding alternative treatment options and where they can obtain additional information; or they may need more specific advice regarding how to keep track of their symptoms and communicate them to their health care practitioner so that complete information is provided. While patient care pamphlets are available to provide general information regarding many common disorders, they are not tailored to individual patients and they include no patient-specific symptom information. Patients generally receive little written information regarding their particular disorder and treatment plan and are provided with no written record of the initial assessment.
Accordingly, there is a need for a combination diagnostic and assessment tool that can be used as the basis for a dialog between a patient and practitioner during the office visit and which is aimed at tracking the patient's symptoms and targeting the treatment for those symptoms as they change over time. Such a tool is needed in order to document treatment progress for the clinician and the patient, as well as for third parties such as insurers and regulatory agencies. There is also a need for such a tool which is very easy to use in order to ensure that it will be used at every office visit. Regular usage of such a tool is necessary in order to track the progress of the treatment program so that the treatment can be promptly adjusted as necessary to optimize the outcome.